The Kirby Institute, UNSW, Sydney, NSW, Australia.
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
HIV Med. 2021 Apr;22(4):294-306. doi: 10.1111/hiv.13017. Epub 2020 Nov 17.
We conducted a longitudinal cohort analysis to evaluate the association of pre-treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV).
Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated-measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds.
Of 4993 PLHIV (66% male), 62% had pre-treatment BMI in the normal range (18.5-25.0 kg/m ), while 26%, 10% and 2% were underweight (< 18.5 kg/m ), overweight (25-30 kg/m2) and obese (> 30 kg/m ), respectively. Both higher baseline and time-updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23-27.5 and > 27.5 kg/m were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9-28.3] and 28.8 cells/µL (95% CI: 6.6-50.9), respectively, compared with normal BMI (18.5-23 kg/m ). PLHIV with BMIs of 25-30 and > 30 kg/m were 1.27 times (95% CI: 1.10-1.47) and 1.61 times (95% CI: 1.13-2.24) more likely to develop CVD risk factors. No relationship between pre-treatment BMI and VF was observed.
High pre-treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort.
我们进行了一项纵向队列分析，以评估治疗前体重指数（BMI）与 HIV 感染者（PLHIV）的 CD4 恢复、病毒学失败（VF）和心血管疾病风险标志物之间的关系。
纳入 2003 年 1 月至 2019 年 3 月期间在一个区域性亚洲 HIV 队列中入组且在开始抗逆转录病毒治疗（ART）前有体重和身高测量值的参与者。使用重复测量线性回归分析与平均 CD4 增加相关的因素。使用 Cox 回归模型分析在 ART 治疗 6 个月后首次出现 VF 和首次出现 CVD 风险标志物的时间。进行了敏感性分析，以调整亚洲 BMI 阈值。
在 4993 名 PLHIV（66%为男性）中，62%的人在治疗前 BMI 在正常范围内（18.5-25.0 kg/m ），26%、10%和 2%分别为体重不足（<18.5 kg/m ）、超重（25-30 kg/m ）和肥胖（>30 kg/m ）。较高的基线和时间更新的 BMI 与 CD4 增加幅度较大相关，与正常 BMI 相比。调整亚洲 BMI 阈值后，较高的基线 BMI（23-27.5 kg/m 和>27.5 kg/m ）与 CD4 增加 15.6 个细胞/µL[95%置信区间（CI）：2.9-28.3]和 28.8 个细胞/µL（95% CI：6.6-50.9）相关，分别与正常 BMI（18.5-23 kg/m ）相比。BMI 为 25-30 kg/m 和>30 kg/m 的 PLHIV 发生 CVD 危险因素的可能性分别是 1.27 倍（95% CI：1.10-1.47）和 1.61 倍（95% CI：1.13-2.24）。治疗前 BMI 与 VF 之间无相关性。
在亚洲 PLHIV 队列中，高治疗前 BMI 与更好的免疫重建和 CVD 危险因素发展相关。
